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Here's some surprising news: According to the National Institutes of Health, Americans spend almost $20 billion per year on vitamins and supplements, up a whopping $6 billion since 1999. Even more surprising? Almost all of them have little or no effect on your health. "For years there has been heated debate within the medical community about supplements helping to reduce the risk of certain diseases, but scientific studies have repeatedly failed to support these claims," says Dr. Arthur Agatston, preventive cardiologist and author of The South Beach Diet® and The South Beach Heart Health Revolution.

Indeed, research from reputable institutions has shown that most supplements cannot prevent or treat diseases. For example, in one study from the U.S. Preventive Task Force (the leading panel of private-sector experts in prevention and primary care), researchers systematically reviewed the efficacy of vitamins A, C, and E; multivitamins with folic acid; and antioxidant combinations said to prevent cancer and/or cardiovascular disease. Their findings demonstrated that while these vitamins won't harm you, they won't help you, either. Furthermore, the Task Force concluded that there is insufficient evidence to recommend taking supplements containing these nutrients. This research bolsters the outcome of numerous earlier studies, including the groundbreaking Heart Outcomes Prevention Evaluation (HOPE) study, published in the New England Journal of Medicine, January 2000, which found no benefit of vitamin E supplementation in heart-disease patients.

The disappointing results of studies on vitamin supplements and their purported health benefits come as no surprise to Dr. Agatston: "I've been following the scientific evidence closely for many years and have always understood that supplements are not the magic bullet for improving health or preventing disease - eating a good variety of vegetables and fruits, along with healthy fats, such as omega-3s and olive oil, is still the optimal way to get the natural vitamins and nutrients that prevent heart attacks, strokes, cancers, and other chronic diseases."

That said, research has shown that one supplement will make a difference: fish oil. Study after study - including the landmark GISSI-Prevention Study, which found that a daily dose of fish oil substantially decreased the risk of sudden death in heart-attack survivors - consistently demonstrates that fish oil helps prevent and treat cardiovascular disease, decreases sudden death from heart attack, and may even stave off Alzheimer's disease.

In addition, fish oil, which contains two omega-3 fatty acids, eicosapentaenoic and docosahexaenoic acids (EPA and DHA), has been shown to reduce the inflammation that is a predictor of heart disease - and that's a result which may help avert the risk of deadly heart attacks or strokes. "A certain amount of inflammation in the body is good because it helps blood to clot and wards off infection," explains Dr. Agatston. "But too much inflammation may cause plaque in the arteries to rupture, leading to a blood clot that could cause a heart attack or stroke. To prevent cardiovascular disease and minimize dangerous levels of inflammation in the body, the one supplement that adult men and women should be taking is fish oil."

The Fish Oil Difference

What sets fish oil apart? "Fish oil supplements meet the standard of what we call a totality of evidence," says Dr. Agatston. "They make biological sense and have been proven effective in large population studies and clinical trials. The evidence is so compelling, even the venerable American Heart Association (AHA) recommends taking fish oil capsules."

"When you take fish oil supplements, you're getting the same oil - or good fat - that you would consume if you ate a piece of fish. But more importantly, studies on consuming fish oil in supplement form alone show notable health benefits, such as lowering triglyceride levels and making the blood less sticky, which prevents clotting and reduces the risk of heart attack and stroke," says Dr. Agatston. The same cannot be said about other vitamin supplements, since research has failed to demonstrate the benefits of these nutrients when they're isolated in a pill. "Taking a vitamin C tablet isn't the same as eating an orange," says Dr. Agatston. "You're missing out on the nutrient's interaction with a host of other micronutrients in the whole food, which scientists are just beginning to study."

In a special brief that appeared in the Journal of the American Medical Association, July 20, 2005, senior nutrition scientists from Tufts University advised that when it comes to disease prevention, studies do not support choosing nutritional supplements over whole foods. These researchers found the most promising results connecting nutrition and optimal health come from changing dietary patterns, not from taking supplements.

Fish vs. Fish Oil?

Interestingly, taking a fish oil capsule daily may be even better than trying to eat fish every single day, given concerns that some fish, including shark, swordfish, king mackerel, and tilefish, contain high levels of mercury. Women who may become pregnant, pregnant women, and nursing mothers should avoid fish high in mercury, which may be harmful to an unborn child or young child's developing nervous system. When it comes to fish oil supplements, you can rest easy - mercury tends to accumulate in the tissue of fish, not in the oil. One study published in the Archives of Pathology & Laboratory Medicine, December 2003, measured mercury levels in five over-the-counter brands of fish oil and found that all had negligible amounts.

"My advice to my patients - and to everyone - is to eat at least two servings of fish per week, and take fish oil every day," says Dr. Agatston. He recommends one to two grams of EPA plus DHA per day, and concurs with the AHA recommendation that people who need to lower their triglyceride levels should take two to four grams per day. (As with all supplements, consult your physician first - high intakes of fish oil may reduce blood clotting so much that it causes bleeding in some people, such as those taking anticoagulants, those with bleeding disorders or uncontrolled hypertension.)

The Vitamin Myth?

Since so little evidence exists to support taking supplements other than fish oil, why are supplements such a big business? The primary reason is that supplement manufacturers spend enormous sums to market their products and consumers take them because popping a pill seems like an easy fix for a poor diet. "Some people may continue taking supplements because they experience a placebo effect, meaning they expect to feel better and thus, they do," says Dr. Agatston.

"Follow a balanced eating plan like the South Beach Diet®, which includes lean proteins, vegetables, beans, legumes, fruits, and whole grains, along with the right fats, and you'll get all the nutrients you need from foods," he adds. "Even in Phase 1, if you eat the recommended vegetables, beans, and proteins, you'll get the essential nutrients for good health," he says.

So now you're ready to opt for whole foods over supplements, but where should you start? The first step is to get educated, says Dr. Agatston. "Americans are overfed, but we are actually malnourished because we are not getting enough nutrients from the foods we consume. My advice: Stick to whole foods that are colorful, have texture, and haven't been processed. And apply the evidence supplied by scientific research to design your eating program and your overall lifestyle with the goal of achieving optimum health. It just makes more sense to splurge on delicious fresh foods that we know can improve our health, than it does to spend money on supplements that have not been proven effective."